Lisbon, Portugal (UroToday.com) PSMA-PET Scan is becoming increasingly popular in the setting of biochemical recurrence after PCa definitive therapy (XRT or RP) for identification of low-volume metastatic disease. However, while better than conventional imaging, it is not perfect.

In this abstract, the authors present their small series of 57 patients at 3 institutions who underwent salvage PLND for single PET avid LN positive on Choline-PET/CT scan following definitive primary therapy for localized PCa. This was a retrospective assessment of their results. 77% were after Radical prostatectomy, 23% were after either EBRT or Brachytherapy. In all cases, patients underwent extended node dissection – including pelvic nodes, iliac nodes and para-aortic nodes (picture of template provided). Hormonal therapy (HT) was only initiated if PSA > 0.2 1-month after surgery. Complete PSA remission defined as PSA < 0.2, and HT was only initiated after PSA progression (Biochemical recurrence).

Of the 57 patients, median PSA was 6.6 pre-operatively, primary PCa had been Gleason 6 (44%), 7 (38%) and Gleason 8-10 (18%). Time to SPND from definitive therapy was approximately 2 years.

Mean follow-up after SPLND was 16.8 months. Median number of nodes removed: 16. LN positivity was confirmed in 93% of patients; 7% did not have histologically confirmed prostate cancer. Importantly 45.3% of cases had nodes discovered in the ePLND that were not identified on the PSMA PET scan; median number of LN mets removed was 3 (even though only 1 was seen pre-operatively). 82.5% had PSA decline. Complete remission without any additional therapy was observed in 23% of patients. As can be expected, PSA decline >90% 1-month post-op was a strong predictor of good long-term response. 3-year BCR-free survival was 21%.

PSA decline:

An important addition to the literature supporting sPLND. Clearly some patients benefit from removal of oligometastatic disease, with delay to HT or no HT.

A major limitation of the study is the use of choline-PET/CT, which is now known to be suboptimal compared to PSMA PET scan.